<!DOCTYPE html>
<head>
<meta charset="utf-8">
<title>Connexion</title>
<!-- <meta name="description" content="slick Login"> -->
<!-- <meta name="author" content="Webdesigntuts+"> -->
<link rel="stylesheet" type="text/css" href="css/style.css" />
<script type="text/javascript" src="js/jquery-latest.min.js"></script>
<script src="js/modernizr-latest.js"></script>
<script type="text/javascript" src="js/placeholder.js"></script>
</head>
<body>
<form id="slick-form" method="post" enctype="multipart/form-data" action="receipt.php" >
<p id="titre"> Entreprise </p>
<label for="firmname">Nom de l'entreprise</label><input type="text" name="firmname" class="placeholder" placeholder="Nom de l'entreprise">
<label for="siretnum">Numero de SIRET</label><input type="text" name="siretnum" class="placeholder" placeholder="Numero de SIRET">
<label for="firmadress">Adresse du siège</label><input type="text" name="firmadress" class="placeholder" placeholder="Adresse du siège">
<label for="zipcode">Code postale</label><input type="text" name="zipcode" class="placeholder" placeholder="Code postale">
<label for="city">Ville</label><input type="text" name="city" class="placeholder" placeholder="Ville">
<label for="country">Pays</label><input type="text" name="country" class="placeholder" placeholder="Pays">
<br><br><br>
<p id="titre"> Boutique </p>
<label for="shopname">Nom de la boutique</label><input type="text" name="shopname" class="placeholder" placeholder="Nom de la boutique">
<label for="shopadress">Adresse</label><input type="text" name="shopadress" class="placeholder" placeholder="Adresse">
<label for="shopzipcode">Code postale</label><input type="text" name="shopzipcode" class="placeholder" placeholder="Code postale">
<label for="shopcity">Ville</label><input type="text" name="shopcity" class="placeholder" placeholder="Ville">
<label for="shopcountry">Pays</label><input type="text" name="shopcountry" class="placeholder" placeholder="Pays">
<label for="activity">Activité</label><input type="text" name="activity" class="placeholder" placeholder="Activité">
<!-- <select name="activity">
    <option value="choix1">Bijouterie</option>
    <option value="choix2">Choix 2</option>
    <option value="choix3">Choix 3</option>
    <option value="choix4">Choix 4</option>
</select> -->
<!-- <form enctype="multipart/form-data" action="fileupload.php" method="post"> -->
  <input type="hidden" name="MAX_FILE_SIZE" value="100000" />
  Transfèrez le K-bis <input type="file" name="kbis" />
  <!-- <input type="submit" /> -->
<!-- </form> -->
<input type="submit" value="Envoyer">
</form>
</body>
</html>